The doctor instructed his patient to stand in front of him. He cupped her crotch and inserted his fingers into her vagina through her clothes, moving his hand repeatedly to her rectal area. Then he squeezed her breasts, according to a formal accusation filed by the Medical Board of California.
The patient, accompanied to the appointment by her 4-year-old granddaughter, asked why that was necessary to diagnose a urinary tract infection, according to the documents. He told her to let him do his job.
In three other cases, the board alleged that the family doctor, Ramon Fakhoury of California's Inland Empire, touched patients' genitals for no medical reason. In 2016, the board handed him 35 months of administrative probation, requiring him, among other things, to have a chaperone when treating females.
Fakhoury did not admit to the allegations, according to his attorney, and criminal charges against him were dropped. If he successfully completes probation next year, he'll be able to practice without restriction.
With a mission of patient protection and doctor rehabilitation _ not punishment _ California's medical board and those in other states make decisions under laws and norms that can seem discordant in the #MeToo era.
California is often cited as one of the more rigorous states in overseeing doctors. But, according to the medical board, very few sexual misconduct complaints are reported to the board in the first place, historically fewer than 200 a year. Even fewer result in a formal accusation against a doctor. And when discipline is found to be warranted _ typically in fewer than 20 cases a year _ the board tends toward leniency, sometimes granting a few years of probation even in instances of severe misconduct, according to a KHN analysis of medical board records.
More than a third of doctors sanctioned by California's board in cases that alleged sexual misconduct received probation in the past 10 years _ some more than once. The terms of probation _ which is not a criminal court action but places conditions on a physician's license _ often required temporary chaperones, as well as psychotherapy and courses in "professional boundaries" and ethics. (Through probation, the medical board can only place conditions or restrictions on a doctor's license in civil proceedings; it does not take criminal court actions.)
"They love giving second chances" to physicians, said Marian Hollingsworth of San Diego, a frequent critic of the California medical board. "It makes you wonder where their priorities are. ... Their first loyalty is supposed to be patient safety and that doesn't always happen."
The recent, shocking reports about years of abuse by USA Gymnastics doctor Larry Nassar and University of Southern California gynecologist George Tyndall _ as well as national exposes about physician misconduct by the Atlanta Journal-Constitution and The Associated Press _ have only intensified concerns about whether sexual abuse is taken seriously enough in medicine.
Nassar, accused of abuse by scores of girls and women under the guise of medical treatment, is now serving what amounts to a life sentence. Prosecutors are considering criminal charges against Tyndall in more than 50 cases, and the state medical board has suspended his license while seeking revocation. He has denied the allegations.
And earlier this month, 17 women sued Columbia University and its affiliated hospitals, alleging that the facilities engaged in covering up decades of sexual abuse by one of its OB-GYNs.
Research has shown that many doctors who sexually exploit patients, like other perpetrators of abuse, don't stop with one victim. They "perpetrate such behavior for years before being stopped," said the authors of one study.
Against this backdrop, California Gov. Jerry Brown in September signed landmark patient protection legislation requiring doctors who are on probation for sexual and other serious misconduct to notify patients of their status and the terms under which they must practice. It will take effect next July. The bill had failed twice before.
"It's time," said the bill's lead author, Sen. Jerry Hill, D-San Mateo. "The #Me Too movement has really made it very clear that there are individuals even in the most respected professions who abuse their authority."
Even as sexual abuse complaints filed with the medical board rose significantly in the past year to coincide with the rise of #MeToo, board officials say they plan no major changes in how the board dispenses discipline in sexual misconduct cases.
The #MeToo movement "has not changed us," said the board's executive director, Kimberly Kirchmeyer. Cracking down on sexual misconduct has always been "one of the board's top priorities," she said.
